The Experience for Shortening The Learning Curve of The Laparoscopic Pancreaticoduo-denectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIJing-dong ^1,2 , LIYong ^1,2,3 , LENGZheng-wei ^1,2 , LIQiang ^1,2 , YANGGang ^1,2 , XUJian ^1,2 , YANZai-hua ^2,3 , TANGXiao-long ^2,3

1. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637007, Sichuan Province, China;
2. Hepatobiliary, Pancreatic & Intestinal Diseases Research Institute, North Sichuan Medical College, Nanchong 637007, Sichuan Province, China;
3. Department of Clinic Medicine, North Sichuan Medical College, Nanchong 637007, Sichuan Province, China;

Corresponding author：

LIJing-dong, Email: lijingdong358@126.com

Keywords：

Laparoscopic pancreaticoduodenectomy; Learning curve

DOI：

10.7507/1007-9424.20160106

Video：

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Objective To investigate how to shorten the learning curve of the laparoscopic pancreaticoduodenectomy (LPD). Methods Clinical data of 5 patients who underwent the LPD in our hospital from May 2015 to November 2015 were retrospectively analyzed. Results The mean age of 58.8 years old. There were four patients who were diagnosed with periampullary tumor, one patient was distal bile duct carcinoma. The median operative time was 588 min, the average blood loss was 290 mL, the time of feeding was 5 days, the mean hospital stay was 25 days. One case died of cardiovascular event on postoperative day 1. One patient had postoperative bleeding after LPD, who recovered smoothly after reoperation for hemostasis laparoscopiclly. Conciusions LPD needs basic learning curve. The key of this procedure are appropriate treatment of pancreatic head and digestive tract reconstruction. Rich operative experience of surgeon in pancreaticoduodenectomy, optimization of the operation process, skilled in laparoscopic procedures, appropriate cases, appropriate perioperative management, and steady surgical team are also important factor for the success of LPD and shorten learning curve.

Citation： LIJing-dong, LIYong, LENGZheng-wei, LIQiang, YANGGang, XUJian, YANZai-hua, TANGXiao-long. The Experience for Shortening The Learning Curve of The Laparoscopic Pancreaticoduo-denectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(4): 398-402. doi: 10.7507/1007-9424.20160106 Copy

1.	Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5):408-410.
2.	Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy:overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg, 2012, 215(6):810-819.
3.	Kim SC, Song KB, Jung YS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy:improvement with surgical experience. Surg Endosc, 2013, 27(1):95-103.
4.	Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery:a qualified systematic review. World J Methodol, 2015, 5(4):238-254.
5.	Liang S, Hameed U, Jayaraman S. Laparoscopic pancreatectomy:indications and outcomes. World J Gastroenterol, 2014, 20(39):14246-14254.
6.	Anderson B, Karmali S. Laparoscopic resection of pancreatic adenocarcinoma:dream or reality? World J Gastroenterol, 2014, 20(39):14255-14262.
7.	Al-Taan OS, Stephenson JA, Briggs C, et al. Laparoscopic pancreatic surgery:a review of present results and future prospects. HPB (Oxford), 2010, 12(4):239-243.
8.	Addeo P, Delpero JR, Paye F, et al. Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity:a multicentre study of the French Surgical Association. HPB (Oxford), 2014, 16(1):46-55.
9.	Tan CL, Zhang H, Peng B, et al. Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curve vs laparotomy. World J Gastroenterol, 2015, 21(17):5311-5319.
10.	Gumbs AA, Gres P, Madureira FA, et al. Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neoplasms. J Gastrointest Surg, 2008, 12(4):707-712.
11.	Chalikonda S, Aguilar-Saavedra JR, Walsh RM. Laparoscopic robotic-assisted pancreaticoduodenectomy:a case-matched comparison with open resection. Surg Endosc, 2012, 26(9):2397-2402.
12.	Wang M, Meng L, Cai Y, et al. Learning curve for laparoscopic pancreaticoduodenectomy:a CUSUM analysis. J Gastrointest Surg, 2016 Feb 22.[Epub ahead of print].
13.	鲁超, 金巍巍, 牟一平, 等.腹腔镜胰十二指肠切除术的学习曲线.外科理论与实践, 2015, 20(6):485-489.
14.	牟一平, 周育成, 朱正纲, 等.从腹腔镜手术谈成立"微创胰胃外科学"之必要.医学与哲学, 2015, 36(1B):23-24.
15.	Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy:feasibility and outcome in an early experience. Arch Surg, 2010, 145(1):19-23.
16.	Gumbs AA, Rodriguez Rivera AM, Milone L, et al. Laparoscopic pancreatoduodenectomy:a review of 285 published cases. Ann Surg Oncol, 2011, 18(5):1335-1341.
17.	Nigri G, Petrucciani N, La Torre M, et al. Duodenopancreatectomy:open or minimally invasive approach? Surgeon, 2014, 12(4):227-234.
18.	Paniccia A, Schulick RD, Edil BH. Total laparoscopic pancreaticoduodenectomy:a single-istitutional experience. Ann Surg Oncol, 2015, 22(13):4380-4381.
19.	Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford), 2011, 13(7):454-458.
20.	Cheung TT, Poon RT, Chok KS, et al. Pancreaticoduodenectomy with vascular reconstruction for adenocarcinoma of the pancreas with borderline resectability. World J Gastroenterol, 2014, 20(46):17448-17455.
21.	Kang CM, Lee SH, Chung MJ, et al. Laparoscopic pancreatic reconstruction technique following laparoscopic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci, 2015, 22(3):202-210.
22.	Kennedy EP, Yeo CJ. Dunking pancreaticojejunostomy versus duct-to-mucosa anastomosis. J Hepatobiliary Pancreat Sci, 2011, 18(6):769-774.
23.	Wang Y, Bergman S, Piedimonte S, et al. Bridging the gap between open and minimally invasive pancreaticoduodenectomy:the hybrid approach. Can J Surg, 2014, 57(4):263-270.
24.	Matsuda M, Haruta S, Shinohara H, et al. Pancreaticogastrostomy in pure laparoscopic pancreaticoduodenectomy-A novel pancreaticgastric anastomosis technique. BMC Surg, 2015, 15:80.
25.	Lei Z, Zhifei W, Jun X, et al. Pancreaticojejunostomy sleeve reconstruction after pancreaticoduodenectomy in laparoscopic and open surgery. JSLS, 2013, 17(1):68-73.
26.	左世东, 廖恒祥.胰十二指肠切除捆绑式胰肠吻合21例临床分析.中国普通外科杂志, 2014, 23(3):395-397.
27.	洪德飞.胰消化道重建个体化选择策略.外科理论与实践, 2015, 20(6):468-471.
28.	苗毅, 高文涛.腹腔镜胰十二指肠切除的规范化相关问题.中华普外科手术学杂志:电子版, 2015, 9(4):9-11.

1. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5):408-410.
2. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy:overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg, 2012, 215(6):810-819.
3. Kim SC, Song KB, Jung YS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy:improvement with surgical experience. Surg Endosc, 2013, 27(1):95-103.
4. Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery:a qualified systematic review. World J Methodol, 2015, 5(4):238-254.
5. Liang S, Hameed U, Jayaraman S. Laparoscopic pancreatectomy:indications and outcomes. World J Gastroenterol, 2014, 20(39):14246-14254.
6. Anderson B, Karmali S. Laparoscopic resection of pancreatic adenocarcinoma:dream or reality? World J Gastroenterol, 2014, 20(39):14255-14262.
7. Al-Taan OS, Stephenson JA, Briggs C, et al. Laparoscopic pancreatic surgery:a review of present results and future prospects. HPB (Oxford), 2010, 12(4):239-243.
8. Addeo P, Delpero JR, Paye F, et al. Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity:a multicentre study of the French Surgical Association. HPB (Oxford), 2014, 16(1):46-55.
9. Tan CL, Zhang H, Peng B, et al. Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curve vs laparotomy. World J Gastroenterol, 2015, 21(17):5311-5319.
10. Gumbs AA, Gres P, Madureira FA, et al. Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neoplasms. J Gastrointest Surg, 2008, 12(4):707-712.
11. Chalikonda S, Aguilar-Saavedra JR, Walsh RM. Laparoscopic robotic-assisted pancreaticoduodenectomy:a case-matched comparison with open resection. Surg Endosc, 2012, 26(9):2397-2402.
12. Wang M, Meng L, Cai Y, et al. Learning curve for laparoscopic pancreaticoduodenectomy:a CUSUM analysis. J Gastrointest Surg, 2016 Feb 22.[Epub ahead of print].
13. 鲁超, 金巍巍, 牟一平, 等.腹腔镜胰十二指肠切除术的学习曲线.外科理论与实践, 2015, 20(6):485-489.
14. 牟一平, 周育成, 朱正纲, 等.从腹腔镜手术谈成立"微创胰胃外科学"之必要.医学与哲学, 2015, 36(1B):23-24.
15. Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy:feasibility and outcome in an early experience. Arch Surg, 2010, 145(1):19-23.
16. Gumbs AA, Rodriguez Rivera AM, Milone L, et al. Laparoscopic pancreatoduodenectomy:a review of 285 published cases. Ann Surg Oncol, 2011, 18(5):1335-1341.
17. Nigri G, Petrucciani N, La Torre M, et al. Duodenopancreatectomy:open or minimally invasive approach? Surgeon, 2014, 12(4):227-234.
18. Paniccia A, Schulick RD, Edil BH. Total laparoscopic pancreaticoduodenectomy:a single-istitutional experience. Ann Surg Oncol, 2015, 22(13):4380-4381.
19. Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford), 2011, 13(7):454-458.
20. Cheung TT, Poon RT, Chok KS, et al. Pancreaticoduodenectomy with vascular reconstruction for adenocarcinoma of the pancreas with borderline resectability. World J Gastroenterol, 2014, 20(46):17448-17455.
21. Kang CM, Lee SH, Chung MJ, et al. Laparoscopic pancreatic reconstruction technique following laparoscopic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci, 2015, 22(3):202-210.
22. Kennedy EP, Yeo CJ. Dunking pancreaticojejunostomy versus duct-to-mucosa anastomosis. J Hepatobiliary Pancreat Sci, 2011, 18(6):769-774.
23. Wang Y, Bergman S, Piedimonte S, et al. Bridging the gap between open and minimally invasive pancreaticoduodenectomy:the hybrid approach. Can J Surg, 2014, 57(4):263-270.
24. Matsuda M, Haruta S, Shinohara H, et al. Pancreaticogastrostomy in pure laparoscopic pancreaticoduodenectomy-A novel pancreaticgastric anastomosis technique. BMC Surg, 2015, 15:80.
25. Lei Z, Zhifei W, Jun X, et al. Pancreaticojejunostomy sleeve reconstruction after pancreaticoduodenectomy in laparoscopic and open surgery. JSLS, 2013, 17(1):68-73.
26. 左世东, 廖恒祥.胰十二指肠切除捆绑式胰肠吻合21例临床分析.中国普通外科杂志, 2014, 23(3):395-397.
27. 洪德飞.胰消化道重建个体化选择策略.外科理论与实践, 2015, 20(6):468-471.
28. 苗毅, 高文涛.腹腔镜胰十二指肠切除的规范化相关问题.中华普外科手术学杂志:电子版, 2015, 9(4):9-11.

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The Experience for Shortening The Learning Curve of The Laparoscopic Pancreaticoduo-denectomy

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